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We would like to thank Singh et al1Singh B. Greenebaum E. Cole R. Carbon-laden macrophages in pleural fluid of crack smokers.Diagn Cytopathol. 1995; 13: 316-319Crossref PubMed Scopus (13) Google Scholar for their interest in our review of “Black Pleural Effusion,” which proposed a classification based on the pathophysiological mechanism. They stated that active crack cocaine use might be a cause of a black pleural effusion via dense deposition of carbonaceous material in macrophage cytoplasm. This may certainly be the case. However, not all patients with crack cocaine use have a black pleural fluid, and the cytoplasmic pigmentation caused by the carbonaceous materials seemed to vary in individual cases (cases 1 and 2), as did the cytoplasmic melanin within the tumor cells in patients with malignant melanoma.2Murali R. Loughman N.T. McKenzie P.R. Watson G.F. Thompson J.F. Scolyer R.A. Cytological features of melanoma in exfoliative fluid specimens.J Clin Pathol. 2009; 62: 638-643Crossref PubMed Scopus (9) Google Scholar Furthermore, many erythrocytes were noted in the crack smokers' pleural fluid sediment smears in their report,1Singh B. Greenebaum E. Cole R. Carbon-laden macrophages in pleural fluid of crack smokers.Diagn Cytopathol. 1995; 13: 316-319Crossref PubMed Scopus (13) Google Scholar which suggests that complicated thoracic hemorrhage or hemolysis might have a potential role in generating black pleural effusions. Examination of a greater number of such cases would be required to develop the precise classification for black pleural effusion. We would like to thank Singh et al1Singh B. Greenebaum E. Cole R. Carbon-laden macrophages in pleural fluid of crack smokers.Diagn Cytopathol. 1995; 13: 316-319Crossref PubMed Scopus (13) Google Scholar for their interest in our review of “Black Pleural Effusion,” which proposed a classification based on the pathophysiological mechanism. They stated that active crack cocaine use might be a cause of a black pleural effusion via dense deposition of carbonaceous material in macrophage cytoplasm. This may certainly be the case. However, not all patients with crack cocaine use have a black pleural fluid, and the cytoplasmic pigmentation caused by the carbonaceous materials seemed to vary in individual cases (cases 1 and 2), as did the cytoplasmic melanin within the tumor cells in patients with malignant melanoma.2Murali R. Loughman N.T. McKenzie P.R. Watson G.F. Thompson J.F. Scolyer R.A. Cytological features of melanoma in exfoliative fluid specimens.J Clin Pathol. 2009; 62: 638-643Crossref PubMed Scopus (9) Google Scholar Furthermore, many erythrocytes were noted in the crack smokers' pleural fluid sediment smears in their report,1Singh B. Greenebaum E. Cole R. Carbon-laden macrophages in pleural fluid of crack smokers.Diagn Cytopathol. 1995; 13: 316-319Crossref PubMed Scopus (13) Google Scholar which suggests that complicated thoracic hemorrhage or hemolysis might have a potential role in generating black pleural effusions. Examination of a greater number of such cases would be required to develop the precise classification for black pleural effusion. Black Pleural EffusionThe American Journal of MedicineVol. 126Issue 12PreviewSaraya et al1 recently published an article that reviewed the possible causes responsible for the development of “black pleural effusions.” Not included in the references was a case report we published describing 2 patients with active crack cocaine (a mixture of cocaine hydrochloride and sodium bicarbonate) use and pleural effusions.2 In both patients, thoracentesis revealed black turbid fluid that on cytologic examination showed dense deposits of carbonaceous material in the macrophage cytoplasm. Full-Text PDF